northampton county health department strategic plan · pdf filenorthampton county health...

Northampton County Health Department

Strategic Plan 2016-2017

Mission

The central purpose and role of the Northampton

County Health Department is defined as:

“Promote, provide, and protect the health and safety of the

citizens of Northampton County.”

Vision

“A culturally sensitive health organization providing quality

services yielding improved health outcomes.”

This document reflects the areas of focus of the Northampton County Health Department

during 2016-2017.

The Northampton County Health Department is committed to carrying out the following

action plan to improve the health of Northampton County residents.

The Leadership Team of the Northampton County Health Department envisions an agency

that strives to meet the following guiding principles.

Health Department acquires and maintains Local Health Department Accreditation

Status defined in policies and protocols maintained by all programs.

Service deliverables and expansion are driven by community need.

Improved efficiency is attained in all divisions.

Health Department recruits, develops and retains a well-qualified, diverse

workforce.

Quality of services is assured through implementation of the quality assurance plan.

Residents experience improved health outcomes and quality of life.

Health Department is accountable to the public in fiscal responsibility and service

delivery.

Efforts are conducted through improved internal collaboration and communication.

Expanded service availability is provided through on-going support by the BOH

and County Commissioners.

Funding is available to support and improve our programs.

Best practices, as recognized by the public health community are utilized in service

provision.

Department is capable of providing a comprehensive response to Public Health

emergencies.

The Northampton County Health Department BOH and Management staff identified

following key strengths, weaknesses, threats and opportunities for Northampton County

Health Department.

Strengths Weakness Threats

Long-term employees

Knowledge of staff

Dedicated staff

Fiscally responsible

Confident clinics

Positive reviews in

client satisfaction

surveys

Technologically

Have not implemented

Electronic Medical

Records yet

County government

does not have a general

working knowledge of

what the Health

Department does

Lack of providers

Budgetary constraints

Federally Qualified

Health Center and

other competition

Cut in funding

Medicaid expansion

State Lab shortfall

Service accessibility

within agency

Decrease in population

current

Nursing Director

Difficulty getting

positions filled

Language barrier

Lack of behavioral/

mental health

resources

Aging in population

Strategic Goals

The following goals were identified in the Healthy Carolinians action plans in response to

the Northampton County Health Department’s Community Health Assessment and by

Northampton County Health Department’s Program Supervisors.

Goal 1 Reduce exposure to second hand

smoke.

Goal 2 Decrease mortality rates of Breast

and Prostate Cancer.

Goal 3 Reduce chronic diseases in

Northampton County.

Goal 4 Develop and maintain a qualified

public health workforce.

Goal 5 Improve the following Home

Health Process Quality Measure:

Improvement in Bed Transferring.

Goal 6 Improve and enhance the Animal

Control and Environmental Health

programs.

Goal 7 Continue to improve Case

Management.

Goal 8 Improve and enhance clerical

efficiency.

Goal 9 Maintain lab certifications.

Goal 10 Continue to improve and enhance

the Nurse Family Partnership

Program.

Goal 11 Continue to improve Clinical

Services.

Goal 12 Improve the Preparedness of the

Health Department and County.

Goal 13 Increase WIC caseload through

outreach.

Goal 14 Improve and Enhance the

Administrative services of the

Health Department.

Community Health Assessment 2014

The Northampton County Health Department in collaboration with members from a variety of

service agencies such as Northampton County Parks and Recreation, Northampton County

Manager’s Office, Northampton County Cooperative Extension, Northampton Chamber of

Commerce, Northampton County Department of Social Services, Northampton County Human

Resources, Eastern Carolina Behavioral Health, Northampton County Schools, Northampton

County Office on Aging, Rural Health Group of North Carolina, Halifax Regional Medical

Center, Choanoke Area Development Association, Northampton County Public Works

Department, and community members all helped to identify health priorities for Northampton

County. Focus Groups, key informant interviews, a community survey and analysis of

secondary data were all used in defining the 2014 Health Priorities. A full copy of the

community health assessment can be found on the departments’ webpage at

www.northamptonhd.com.

Priorities identified in the 2014 Community Health Assessment are:

1) Cancer (Breast/Prostate)

2) Drug/Substance Abuse (Tobacco)

3) Physical Activity/ Nutrition

Cancer (Breast/Prostate)- As of July 1, 2014 The United States Census estimates North

Carolina’s Population is 318,857,056 and Northampton’s Population is 20,463. The

African American Population for the state is 13.2% and for Northampton County the

African American Population is 58.4%. The Female population for North Carolina is

50.8% and for Northampton the population is 51.8.

Source: United State Census Quick Facts

From 2009 -2013 the mortality rate for Breast Cancer in Northampton County is 3%

higher than the rate of breast cancer for the state.

Source North Carolina Cancer Registry, 1/2015

The July 1, 2014 The United States Census estimates North Carolina’s Population is

318,857,056 and Northampton’s Population is 20,463. The African American

Population for the state is 13.2% and for Northampton County the African American

Population is 58.4%. The male population for North Carolina is 49.2% and for

Northampton the male population is 48.2

Source: United State Census Quick Facts

http://www.northamptonhd.com/

From 2009 -2013 the mortality rate for Prostate Cancer in Northampton is 16.9% higher

than for the state for the same time period.

Source: North Carolina Cancer Registry, 1/2015

Drug/Substance Abuse (Tobacco)- The rate of current smokers in Eastern North

Carolina is .7% higher than the rate for North Carolina

Source: 2013 State Center for Health Statistics – 2013 BRFSS Tobacco Use Survey

Results.

Physical Activity/Nutrition- In Eastern North Carolina 3.2% of residents have a body

mass index (BMI) greater that the state.

Source: 2013 BRFSS Survey Results: Eastern North Carolina

Department Work plan

Goal 1 Reduce exposure to second hand smoke.

Objective # 1 Decrease tobacco use in public/multi-unit

housing by five percent.

Baseline Data Rate of Current smokers in Eastern North

Carolina 20.9%

Rate of current smokers in North Carolina

20.2%

Source North Carolina State Center for Health

Statistics 2013 BRFSS Survey Results.

CHA Priority Addressed Tobacco

Activities Lead Person Partners

N=New;

E=Existing

Timeframe

Continue

collaborations with

schools, child care

centers, faith

communities, and

public housing on the

harmful effects of

tobacco use including

e-cigs.

Virginia McClary October 2017

Work with

Management in

developing a Tobacco

Free Policy.

Utilize the HUD

Tobacco Free Policy

in developing the

policy


Goal 2 Increase life expectancy by decreasing

Breast and Prostate Cancer rates.

Objective # 1 Increase the percentage of adults

reporting good health by 7%

Baseline Data Would you say that in general your health is?

Excellent Very Good Good

NC 18.3% 34.4% 31.0%

NH 18.2% 27.4% 34.3%

Source North Carolina State Center for

Health Statistics

2013 BRFSS Survey Results

CHA Priority Addressed Cancer


N=New;

E=Existing

Timeframe

Continue to educate and

urge individuals to get

screened.

Virginia McClary Monthly

Goal 3 Reduce chronic disease in Northampton

County.

Objective # 1 Increase the percentage of adult citizens

receiving the recommended amount of

physical activity by five percent.

Increase the percentage of Adult Citizens

consuming five - nine daily servings of

fruit and vegetables by five percent.

Baseline Data

Adults with a BMI of 25%

North Carolina - 66.1%

Northampton County – 69.3%

North Carolina state Center for Health

Statistics BRFSS Results 2013

CHA Priority Addressed Physical Activity and Nutrition


N=New;

E=Existing

Time Frame

Promote Healthy Eating

and physical activities in

communities of faith

Utilize the Faithful

Families Eat Smart

Curriculum

Conduct 9 lessons on

Eating Smart and Moving

More – co taught by a Lay

Leader


Promote and Increase

participation in the

Diabetes support groups in

Jackson and Rich Square


Start a new Diabetes

Support Group in

Garysburg

Virginia McClary January 2017

Goal 4 Develop and maintain a qualified public

health workforce.

Objective # 1 Educate and train staff annually.

Baseline Data Staff is receiving appropriate trainings on

an annual basis.

CHA Priority Addressed N/A


N=New;

E=Existing

Time Frame

Safety Training Megan Vick November 2016

Respiratory Fit Testing Megan Vick November 2016

Cultural Diversity/

Customer Satisfaction

Training

Megan Vick April 2017

Goal 5 Improve the following Home Health Process

Quality Measure: Improvement in Bed

Transferring

Objective # 1 Improve Outcome percentage on Bed

transfers to 63%.

Baseline Data Based on 12 month time period 7/2015 –

6/2016 from the Casper Reporting system-

Agency Rate =52%



N=New;

E=Existing

Time Frame

Improve assessment

strategies for clinicians by:

-staff education on transfer

scoring from OASIS

guidance manual

-staff education on safety

factors affecting the correct

scoring of bed transfers

Susan/ Anneke Run Casper process

report October 2017

for most recent 12

month time period

available (it should be

7/2016-6/2017)

On multidisciplinary

patients, the assessing

clinician will confer with

other team members, such as

therapy or aide to assure

accuracy and consistency in

transfer scoring.

Susan/ Anneke Run Casper process

report October 2017

for most recent 12

month time period

available (it should be

7/2016-6/2017)

Goal 6 Improve and enhance the Animal Control

and Environmental Health programs.

Objective # 1 Have Animal Control Attendant trained

and certified as a County Certified Rabies

Vaccinator.

Baseline Data Currently, the Animal Control officer is

the only agency employee who is trained

and certified as a Certified Rabies

Vaccinator.

Objective #2 Develop/ modify office procedures to

make EH office easier to “negotiate” for

clients coming in for EH/ Animal Control

services.

Baseline Data Currently, the office is not entirely

conducive to accommodate clients.



N=New;

E=Existing

Time Frame

Have the Animal Control

Attendant attend and

complete necessary

training(s) to acquire state

certification.

Dana Hardin October 2017

Rearrange/ refurnish office

as necessary to better

accommodate clients.

Adopt or change official

policies as needed to

accomplish goal.

John White October 2017

Goal 7 Continue to improve Case Management.

Objective # 1 Increase and maintain case load of 30 to

35 annually.

Baseline Data As of November 1, 2016, the caseload is

currently 29.



N=New;

E=Existing

Time Frame

Increase and maintain

caseload of 30-35

Carol Lee October 2017

Goal 8 Improve and enhance clerical efficiency.

Objective # 1 Train another clerical staff member on

Environmental Health clerical aspects

such as knowledge of prices, etc.

Baseline Data Currently there is only one staff member

who is trained on EH clerical duties.



N=New;

E=Existing

Time Frame

Supervisor will pick a

clerical staff member to be

trained in EH clerical

duties especially

knowledge of prices of EH

services, etc.

Julie October 2017

Goal 9 Maintain lab certifications.

Objective # 1 Maintain CLIA certification

Baseline Data Lab is up for CLIA recertification. The

last certificate was issued in November

2014.

Objective #2 Maintain water certification.

Baseline Data The last certificate was issued in August

2016.



N=New;

E=Existing

Time Frame

Pass CLIA inspection Birdie Outland

April 30, 2017

Pass proficiency test twice

a year to maintain water

certification.

Birdie Outland February and July of

2017

Goal 10 Continue to improve the Nurse Family

Partnership Program.

Objective # 1 Staff will attain and maintain a caseload

of 25 clients.

Baseline Data As of November 1 2016, one nurse home

visitor (nhv) has a caseload of 25, one nhv

has 21 clients, one nhv has 18 clients, one

nhv has 15 clients, and one nhv has a

caseload of seven (new and is building

caseload at the rate of three to four clients

a month.



N=New;

E=Existing

Time Frame

Nurse will enroll above 25

clients when she has

several inactive clients or

when a client is on a

reduced visit schedule.

All NHV September 2017

Increase outreach to

increase number of

referrals. (hospitals,

churches housing schools,

pregnancy care centers,

OB/GYN’s in all five

counties)

All NFP Staff September 2017

Monitor retention rates

including pregnancy,

infancy, and toddler stages.

Tia Alfonso

Monthly

Enroll at least three to four

clients per month until full

caseload achieved.

All NHV Monthly

Goal 11 Continue to improve and enhance Clinical

Services.

Objective # 1 Implement LARC in OB and FP clinic.

Baseline Data LARC is the most effective method for

preventing unplanned pregnancy and is

not offered.

Objective # 2 Obtain Meaningful Use with Cure MD.

Baseline Data Attestation for Meaningful Use is in

process.

Objective # 4 Complete Nurse Competency policy,

process, and develop tools for clinical

nursing staff for clinical nursing staff.

Baseline Data A policy has been developed. It needs to

be approved by the BOH.

Objective # 5 Revise audit policy to include coding

audit.

Baseline Data Coding audit is not in the current policy.



N=New;

E=Existing

Time Frame

Implement LARC in OB

and FP clinic.

Judi Northcott (N) Dr. Singer

(N) Linda Cross

(N) WHB nursing

consultant

January 1, 2017

Obtain Meaningful Use

with Cure MD including

utilizing the system as an

EHR, e-prescribe, lab, and

patient portal.

Judi Northcott (N) Angela Holley

(N) Julie Martin

March 2017

Complete Nursing

Competency policy and

develop tools for clinical

nursing staff.

Judi Northcott December 31, 2016

Begin a process for

evaluations using new

Nursing Competency

policy.

Judi Northcott January 2017

Revise Audit policy to

include coding audit.

Judi Northcott

Julie Martin

Prior to next

scheduled chart audit

Goal 12 Improve the Preparedness of the Health

Department and County.

Objective # 1 Complete all AA requirements for the

Ebola AA that ends May 31, 2017.

Baseline Data Before May 31, 2017, there are certain

requirements and plans that need to be

addressed that are listed below.

Objective # 2 Conduct a tabletop for security functions

as it relates to POD management and

medical countermeasure materials.

Baseline Data Currently, there has not been a tabletop

done.



N=New;

E=Existing

Time Frame

Complete Home Health

tabletop exercise

Megan Vick/ Home

Health staff

November 2017

Conduct one informational

sharing session for Zika.

Megan Vick May 2017

Develop and implement a

public health message

campaign for mosquito

vector control.

Megan Vick May 2017

Write a Concept of

Operations plan

Megan Vick May 31, 2017

Conduct a tabletop on POD

operations specifically

targeting security

Megan Vick Sheriff Smith May 31, 2017

Goal 13 Increase WIC Caseload.

Objective # 1 Increase WIC Caseload by Outreach to

Healthcare Providers and Public Assistant

Offices.

Baseline Data



N=New;

E=Existing

Time Frame

Place WIC outreach posters

in county facilities

including DSS, Private

Provider Offices, etc.

Sheila Person October 2017

Place brochure holders

with outreach materials in

Private Provider Offices,

Convenience stores and

maintain on a quarterly

basis

WIC Staff Quarterly in 2017

Goal 14 Improve and enhance the Administrative

services of the Health Department.

Objective # 1 Train Administrative Assistant on

HIPAA, Spiceworks, State Budget, and

the contract system.

Baseline Data New staff member started on October 24

and has started training.



N=New;

E=Existing

Time Frame

Train Administrative

Assistant on HIPAA,

Spiceworks, State Budget,

and contract system.

Cheryl Warren October 2017

Updates from 2015-2016 Strategic Planning

Tobacco

Provide education and activities during health awareness months in child care

centers, schools, faith communities and multiunit/public housing. Goal Met

Work with management in developing a Tobacco Free Policy. Utilize the HUD

Tobacco Free Policy in developing the policy. Goal On-going

Provided education and activities on tobacco use and exposure to residents in public

housing during the health awareness months for Heart Health, Colon Cancer Awareness,

Minority Health Awareness, Asthma and Allergy Awareness, Stroke, and Women’s

Health.

Provided resources and information for display in common areas on tobacco use for all

public housing facilities.

Provided Regional Director with information from the State on tobacco use in public

housing, including how to implement a policy to become a tobacco free facility.

Provided smoking cessation class at one public housing site.

More than 250 middle and high school students attended a presentation by a former teen

tobacco user and throat cancer survivor.

35 5th grade students received education on puberty and healthy life styles including

tobacco use and e-cigs.

Five faith based communities received education on healthy life style changes including

tobacco use.

Three child care centers received education on healthy life styles for youth including

tobacco use and e-cigs.

Cancer

Breast

Provide education and activities to improve general health during health observance

months in faith based communities. Goal Met

79 female participants from three faith based communities received education on

women’s health issues including breast cancer.

25 women participated in a breast cancer education conference and screening.

Prostate-

Provide education and activities to improve general health during health observance

months in faith based communities. Goal Met

46 participants in four faith based communities received education on prostate health

during Men’s Health month.

Male offenders in one correctional facility received education on men’s health issues

including prostate cancer and healthy lifestyles.

88 men were screened for prostate cancer including 47 African American males.

Physical Activity and Nutrition

• Promote healthy eating and physical activity in communities of faith. Utilize the

Faithful Families Eat Smart Curriculum. Conduct nine lessons on Eating Smart and

Moving More – co taught by a Lay Leader. Goal met

• Implemented the Faithful Families Eat Smart Move More Curriculum in two faith based

communities.

• Education was provided on:

Plan what is for dinner

Shop - Get the Best for Less

Shop for Value, Check the facts

Fix Fast eat at Home

Choosing More fruits and Vegetables

Fix it Safe

Making Smart Drink Choices

Choosing to move more

Making the Connection

• Food preparation, food tasting and physical activity are included in the lessons.

• 17 individuals participated in the curriculum

Develop and maintain a qualified public health workforce.

Educate and train staff annually. Goal met

Safety Training completed November of 2015

Respiratory Fit Training completed November of 2015

Cultural Diversity/ Customer Service Training completed May 2016

Improve Home Health process

Improve the Home Health process measure for timely initiation of care.

Goal was 90%, Goal met with 92%.

Environmental Health

Conduct renovations and improvements to the agency’s pound. Goal Met

During spring 2016, major Facility upgrades were completed by J.T. Barnes Construction

at the Facility. These renovations included new fencing in the runs, painting, ceiling

installation, door repair, roof repairs, front of building improvements, and the installation

of County Water.

These renovations should allow our Facility to better comply with NC Dept. of

Agriculture and Consumer Services Animal Welfare Laws and Rules. Additionally, the

appearance of the facility is greatly improved, and the interior is much cleaner and

brighter, which also has the benefit of improving the safety of the shelter for both staff

and animals.

Case Management

Continue to improve Case Management. (Increase and maintain a caseload of 35-45

annually) Goal not met

Goal not met because screenings are not received in a timely manner and deferrals are sometimes

three to four people in a month’s time. Staff member is averaging 30-35 right now.

Identify one person at pregnancy medical home for contact about pregnancy risk

screenings. Goal not met

Goal not met because all nurses complete screenings for patients. Staff member has no problem

getting what she needs from the nurses if the screening is not completed.

Clerical

Improve the efficiency of the clerical aspects of General Clinic. Develop a new appointment

system for sick patients and STD’s. Goal met

Clerical staff member did not complete QI 101 Training. The project was still conducted and

completed. Appointment books for STD scheduling and Nurse Practitioner’s scheduling are

being used.

Lab

Improve Lab efficiency. Have the FP Lead Nurse proficient in lab. Goal not met

After multiple attempts to get staff member in lab, nurse is still not proficient in UPT,

Hemoglobin, Glucose, finger sticks, and venipunctures after a year.

No other staff member was trained to read wet mounts and report out no growth GC plates. Goal

not met

Nurse Family Partnership

Staff will attain and maintain a caseload of 25 clients. Goal not met with the exception of one

nurse.

One nurse is at caseload, one at 21, one at 19 and the 2 new nurses are building their case load

and are not expected to have 25.

Increase pregnancy retention rate from 72.7% to 90%. Goal TBD

Cannot update this statistic at this time due to problems with the data at the national level.

Maintain our infancy retention rate above 80%. Goal TBD

Cannot update this statistic at this time due to problems with the data at the national level.

Increase our toddler retention rate from 80.5% to 90%. Goal not met

Our Toddler Retention rate has improved to 82.9%

Maintain our premature birth rate below 11.4%. Goal met

Our premature birth rate for this year is 0%.

Decrease low birth weight rate from 8.3% to 7.8%. Goal met

Low birth weight is 6.9%

Clinical Services

Continue to improve and enhance clinical services. Explore ways to increase access to

Long-Acting Reversible Contraception (LARC) for all appropriate patients. Goal not met.

Goal modified.

With no trained provider for LARC we were unable to utilize the available funding to purchase

the LARC devices. New OB contracted physician will implement LARC when here for clinic.

Obtain Meaningful Use with Avatar. Goal modified due to the approval of a different system.

About 10% complete. New EHR vendor CureMD was approved after an extended contract

process. The time it took to get the legal teams (on both sides) to approve the contract hindered

full implementation this year. Current status – Attestation for Meaningful Use is in process.

Awaiting payment of invoice for 25% of the system so that we can move forward. Full

implementation will include policy overhaul of HIPAA and Medical Records policies; staff

training and setting a “go-live” date and then going live. Time frame is hard to predict and

dependent on Cure MD schedule, local IT and staff education.

Develop Nurse Competency policy, process, and tools for clinical nursing staff for each

Public Health Nursing position. Goal on-going.

50% complete – The policy has been developed but has not been taken to the BOH for approval.

It has not been shared with staff nor implemented at this time.

Supervisor is developing competency tools. New training orientation and competency tools for

FP and title X have been sent out by WHB for October 1 implementation. These need to be

added to the FP policy.

Begin pre-work for completion of the Practice Management Consultative support. Goal not

met. No longer needed.

Many health departments have ceased to request Practice Management Consultative support.

This is no longer a goal for us.

Bioterrorism

Improve the Preparedness of the Health Department and County. Complete Home Health

tabletop exercise. Goal not met

Home Health staff decided to wait to do this until further information on the new requirements

are pushed down.

Conduct Respiratory Fit Testing for LE and EMS. Goal met with the exception of EMS

EMS has not moved forward with wanting testing.

Conduct PPE training on Ebola PPE. Goal met

PPE training on Ebola PPE completed April 2016.

Update Isolation and Quarantine Plans to be compliant with Ebola AA. Goal met

Write an Ebola Virus Disease Response Plan to be compliant with Ebola AA. Goal on-going

due to date change

Agreement Addenda changed completion date to May 2017.

Begin process of developing a special needs registry for at risk populations for the health

department and county by meeting with Ronnie Storey and Chuck Joyner. Goal met

Meeting was held July 21st.

Attend monthly drill task force meetings. Goal met

WIC

Increase WIC caseload by Outreach. Increase WIC Caseload by Outreach to Healthcare

Providers and Public Assistant Offices. Goal met

Outreach posters were placed in private provider officers in Northampton and Halifax counties.

Outreach material was placed in county stores. Brochure holders and materials were placed in

private provider offices in both Halifax and Northampton Counties. A check to replenish

brochures is scheduled quarterly.

Administrative

Improve and enhance the Administrative services of the Health Department. Train

Administrative Assistant on State funding. Goal on-going due to staff change.

The Administrative Assistant was being trained on the State Budget. We had discussed

Agreement Addenda and had begun to learn the expenditure report that is necessary to claim

State funding in the WIRM. The AA took another position on September 12, 2016. Her

replacement was hired on October 24, 2016. Once her initial orientation is complete, we will

begin the process. We have already discussed what the Agreement Addenda is and when they

are received from the State.

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